多发性骨髓瘤合并肾功能不全的临床分析

Clinical analysis of multiple myeloma with renal insufficiency

目的分析多发性骨髓瘤伴肾功能不全患者的临床特征，探索多发性骨髓瘤患者肾功能不全的发生率、危险因素及防治策略。方法回顾性分析我院2010年1月1日至2013年5月10日住院患者共80例，将其分为多发性骨髓瘤合并肾功能不全组和非肾功能不全组，进行两组间临床资料的比较。结果80例患者中，31例合并肾功能不全，占38．9％；分型以轻链型最多见，占48．4％；kA型占25．8％，IgG型占25．8％。非肾功能不全组以IgG型多见，占61．2％；轻链型占14．3％，IgA型占18．4％，其他类型6．1％。两组资料对比显示，肾功能不全组高钙血症、高尿酸血症的发生率显著高于非肾功能不全组，部分患者经过积极治疗，肾功能可恢复正常。结论肾功能不全为多发性骨髓瘤患者最为常见也是最为严重的并发症之一。免疫分型、高钙血症、高尿酸血症是多发性骨髓瘤并发肾功能不全的重要影响因素。肾功能不全的发生使患者的治疗更为复杂，疾病更易发生进展，如能及早发现、及时治疗多发性骨髓瘤及其肾损害，则有望逆转肾功能，改善患者预后。

Objective To observe the clinical characteristics of multiple myeloma patients complicated with renal insufficiency and analyze the incidence, risk factors and prevention strategies of renal insufficiency in multiple myeloma patients. Methods A retrospective analysis of our hospitalized multiple myeloma patients from January 2010 to May 2013 was done. A total of 80 multiple myeloma cases were divided into multiple myeloma with renal insufficiency group and multiple myeloma with no- renal dysfunction group. Clinical data between the two groups were compared. Results Among 80 multiple myeloma patients, 31 patients were complicated with renal dysfunction, accounting for 38. 9%. The most common type was light chain, accounting for 48. 4%, followed by IgA type, accouting for 25. 8%. There were 49 cases of non-renal dysfunction. The most common type was IgG, accounting for 61.2%, followed by IgA type （18. 4~）, light chain type （14. 3%）, and other types （6. 1%）. Compared to the non-renal dysfunction group, the levels of serum calcium and uric acid were significantly increased in renal dysfunction group （P〈（0. 05）. The renal dysfunction in some patients could be reversed to the normal level after effective chemotherapy given. Conclusions The renal insufficiency was the most common and serious complication in multiple myeloma patients. The multiple myelorna type,hypercalcemia and hyperuricemia were important factors for multiple myeloma patients to develop renal insufficiency. It became more complicated for multiple myeloma patients with renal insufficiency to get effective treatment. The prognosis became poorer. Early detection and timely treatment of multiple myeloma patients with renal insufficiency was very important.